Rania Habib, MD, DDS (Host): Welcome to Hally HealthCast, the wellness podcast from Hally Health, your partner in helping you live your healthiest life. Every episode on our podcast addresses a new topic important to your health and wellbeing, bringing in doctors, specialists, and other health experts who offer advice and answer your most pressing questions.

Today's episode is all about cancer prevention. February is National Cancer Prevention Month, so it's the perfect time to learn more about this important topic. I'm your host, Dr. Rania Habib. Here with us today is Hannah Dignan. She's a Nurse Practitioner at Carle Cancer Institute in Urbana and Danville. Welcome, Ms. Dignan, and thank you so much for being with us today and for sharing your knowledge.

Hannah Dignan, MSN, APRN, AGNP-BC, AOCNP, CBCN: Thank you so much for having me. It's good to be here.

Host: Let's begin with the cold hard facts about cancer. The federal government estimates that nearly 2 million Americans will be diagnosed with cancer. Now these are cancers other than non-melanoma skin cancer this year, and that more than 600,000 may die from this disease.

Yet research shows that more than 40 percent of these cases and nearly half of the deaths can be attributed to preventable causes, smoking, excess body weight, physical inactivity, and excessive exposure to the sun among others. Ms. Dignan, is cancer actually preventable? Do the basic lifestyle choices each of us makes every day really make that much of a difference?

Hannah Dignan, MSN, APRN, AGNP-BC, AOCNP, CBCN: Of course. With any kind of cancer, there are a variety of factors which contribute to a person having these cancer diagnoses. One of which is not having adequate access to quality health care and physical checkups. For instance, pancreatic cancer can be caused by uncontrolled diabetes, excess alcohol use, sedentary lifestyle. Some other cancers can be attributed to carcinogenic exposures, such as exposure to smoking, cigarette, cigar, tobacco, any kind of inhaled toxins. Where I work in, more rural communities, a lot of the cancers that we're seeing are fallout from long term exposure to factory jobs or asbestos. So those are some of the preventable exposure reduction things to consider, or something to consider when you're dealing with a patient.

Where are they? What is the environment that they live in? The other things that are things that people can control, however, are those lifestyle factors. We know that obesity attributes to a variety of health concerns that are non-oncologic. However, in the context of cancer, excess adipose tissue can predispose someone to having a more pro-inflammatory state and can also predispose someone to having excess hormones or essentially making the body work much harder than it would have with adequate or normal BMI.

And so one of the things I counsel my patients on is ensuring that they are making exercise a priority and not just anything. I usually say 150 minutes of exercise per week, mixing between aerobic and resistance training. And truthfully, when we look at the literature, it helps prevent secondary cancers or primary cancers significantly.

Pretty much all cancers can have some element of a prevention component to it if you really were to look at every single thing. Of course, there are some things that are just random coding changes, but a lot of cancer subtypes, pretty much all of them, have some sort of a prevention with healthy living.

Host: Thank you, Ms. Dignan. That was a super summation of the whole reason for National Cancer Prevention Month. There's something each of us can do to improve our chances of not getting cancer. Of course, there are at least as many possible causes of cancer as there are different forms of cancer, and many of those are seemingly beyond our control, such as family history, for example.

What can we do as individuals if we suspect, for whatever reason, that we may be at high risk for developing cancer?

Hannah Dignan, MSN, APRN, AGNP-BC, AOCNP, CBCN: Well, the first thing to look at is in a situation where I counsel a patient, for instance, is to look at what that family history is. Is there a family tree that potentially you need to put together? The first thing I look at is our family, of course, because if we have a lot of family members with cancer, then one could argue that we have a higher risk of a predisposition to cancer.

Now, then I look at the cancer subtypes, the ages in which people were diagnosed. Those types of factors can give us a lot of information. If we have four family members with pancreatic cancer, we wonder maybe there might be something going on here, especially because some of those rarer subtypes may be more at risk for a genetic mutation.

The other things I look at is the age in which people were diagnosed. As we know, as we age, especially after 50, our risk for developing cancer goes up significantly. And that a lot has to do with normal aging process. The DNA miscoding can definitely start to be more prominent and can put someone more at risk for developing a cancer. Now, I get asked all the time, especially in the high risk breast clinic, do I need to get genetic testing? Well, sometimes it's not that simple. So I look at the patient and I ask them, okay, so let's go through this family history very in depth. And as in depth as I possibly can, I look and see which would be the person in that family that would be the most appropriate to receive genetic testing, because what genetics is going to show us is if there is a gene mutation within the family, that may be the causative issue that predisposed that person to develop their primary cancer.

If that person is still alive and able to get tested, that person should be the first person that we should contact to see if they can get genetic testing. If that person has no gene mutation, then we know that that is likely not the cause of their cancer. And then the first degree relative of that person doesn't necessarily need testing.

But, of course, even in the absence of a gene mutation, the patient in front of me may still qualify for more high risk screenings, such as earlier colonoscopies, more frequent pap smears or earlier breast imaging. But of course, if the person's first degree relative is no longer with us, of course, that person would be able to get genetic testing. But the most informative person to be tested is the person who had cancer in most instances.

Rania Habib, MD, DDS (Host): Thank you, Ms. Dignan, that's a lot to consider. You know, I think we oftentimes think that we're going to only genetic test the person who's worried about it, but it makes a lot of sense to go for that first degree relative that actually has the cancer. You did mention that early detection plays a significant role in cancer prevention.

What more can you tell us about the benefits and options available specifically for cancer screening?

Hannah Dignan, MSN, APRN, AGNP-BC, AOCNP, CBCN: The first thing I mention is screening is in the asymptomatic state, and I counsel my patients on this. This is a part of routine healthcare, and it should be considered as such. So the likelihood we are going to catch a cancer early is quite high if we start it at the appropriate time. So the American Cancer Society, the United States Preventative Services Task Force, and a variety of other institutions offer good screening guidelines and when we should start.

In the general state, we are constantly updating this literature. And so it's important for clinicians, whether you work in oncology or you work in primary care, that you're up to date with when a person should start screening, because that is what is going to prevent cancer or promote early detection.

For instance, the United States Preventative Services Task Force this year lowered the recommendation for starting mammography starting at 40, whereas the recommendations were 45 and 50 a few years earlier. That is because the mean age of diagnosis is starting to be more like 50 instead of 60.

 And so getting that extra screening in there will help prevent a person from being metastatic at diagnosis is how I look at it. So I look at what is the most appropriate screening for you and your risk factors, as well as what is the most appropriate timing in which a person should start. If you have a family member who is diagnosed with colon cancer at 45, then starting colonoscopies at 45 is not going to be appropriate for you. We should probably start at 35, especially if that was a first degree family member. So we take all of that family history in consideration.

Rania Habib, MD, DDS (Host): What about some of the local options available for cancer screening?

Hannah Dignan, MSN, APRN, AGNP-BC, AOCNP, CBCN: So at Carle Foundation, we have very good cutting edge screening tools. For instance, we have access to advanced endoscopy, colonoscopies for screening for colon cancer. We have a lung nodule clinic, which is very cutting edge. So there's screening now for lung cancer, which is very exciting. If you had a 30 pack year smoking history, instead of just I'm kind of hoping that we catch it early; we actually have justification to get low dose CAT scans, and we have a dedicated Nurse Practitioner who reviews those CAT scans, or she meets with people who have had lung nodules found on incidental screenings to help detect a cancer early. In addition to that, we also have a group of dedicated breast radiologists who are incredible.

I do have to admit that, and they are able to do a variety of cutting edge breast imaging and screening tools, including 3D digital tomosynthesis mammography, as well as breast MRIs. So we have a lot at Carle. Of course, the other things that we screen for are skin cancers, which can be done through our dermatology team.

And we also offer a medical geneticist for those folks that we had mentioned up above who may have been found to have a rare genetic mutation that predisposes you to multiple different types of cancer.

So, you know, we don't have to just wait around until that person gets cancer. We can look at the guidelines, see what types of cancers those persons might be more predisposed to, and then screen them appropriately based on the guidelines. And so finding out that information and tailoring the care is what is so necessary for people and then is something that we are able to provide here at Carle.

Rania Habib, MD, DDS (Host): Thank you for that information. It's definitely potentially life saving, Ms. Dignan. Okay, so worst case scenario, we do a self exam and find a lump. Or, as you mentioned, we get an MRI and there's a spot there that shouldn't be. All of a sudden, there's tangible cause for concern. What's our next step and the steps after that?

Hannah Dignan, MSN, APRN, AGNP-BC, AOCNP, CBCN: Well, specifically for breast cancer, I always say first things first is don't panic. Please call your provider. For instance, if we have a patient who is self detecting a breast lump or sees another concerning breast finding, please make an appointment to get in to see your primary care provider or one of their colleagues.

What might be the next step would be, especially if it's a breast imaging, next step would be that they're going to order a workup via imaging. And of course, this would be after they perform the exam.

For a breast lump, they'd order a mammogram and an ultrasound to look specifically at that spot. At that same appointment, you will be told what the next steps are by our fellowship trained breast radiologists, which is quite awesome.

If there is a biopsy that is recommended, they will schedule that for you. And then we wait, we wait. And I know that that's hard. But we wait for our answers. We wait to see what the next steps are. Of course, if everything is benign, then we would resume normal screening. I usually say self detecting things is potentially something that is the first line of defense.

You know your body better than we do. I see hundreds of patients a month, and I can't remember what everybody's exam feels like. But you live in your own body. So I always say whatever you feel, and if it's something minute, just let me know and I can see what the next steps are. For incidental findings on mammography or MRI, usually the next steps will be ordered by our radiology team or recommended by our radiology team.

And we often defer to them because they know what they're seeing and they know what would best characterize that area. But of course throughout the continuum of care, if there is any issues, your provider or their staff will be able to walk you through things.

Rania Habib, MD, DDS (Host): Thank you for that detailed answer, Ms. Dignan. You've definitely given us a lot to think about during this National Cancer Prevention Month. The news about cancer is getting a lot better, isn't it? With ongoing breakthroughs in medical research and advances in technology and treatments, is it safe to say that there's cause for hope? What's the most positive message you have for us today about cancer?

Hannah Dignan, MSN, APRN, AGNP-BC, AOCNP, CBCN: I am very encouraged by the amount of different screening tools that are available to us this year and in the subsequent years. I think that getting that appropriate screening can save lives. We don't need to be afraid of the cancer screening. Just because you don't do it doesn't mean it's not there, and so make it a part of your routine health care.

It can save your life, and it can save your loved one's life as well. Timing it appropriately, making sure that it's the right test for you, and then also making sure that you tell your provider about any symptoms that you might be dealing with. But long and short, the cancer detection modalities that we have are very good and they're very specific to cancer, meaning that they have the highest rate of true positives.

They're going to most of the time detect it. And so when you go in for your screenings, just know the literature is in your favor. It's when we are delaying screenings or missing things is when the majority of those things go and progress a little further, but treatment is also getting a lot better as well.

And so I don't want to diminish everything, saying that once we get that cancer diagnosis, we're not doing very well. We have a lot of excellent cutting edge research available to us that is giving us new hope as well.

Rania Habib, MD, DDS (Host): That's so encouraging to hear, Ms. Dignan. Okay, last question for you. If you could drive home one key message about National Cancer Prevention Month, what would it be? What would you want everyone to know?

Hannah Dignan, MSN, APRN, AGNP-BC, AOCNP, CBCN: From my experience, just know that there are so many different things that we can control when it comes to preventing cancer or detecting it early. And knowing what each one is for us will help us to have a better chance of having better outcomes.

So what I mean by that is, of course, we talked about it earlier, but lifestyle factors like diet, exercise, limiting alcohol use, limiting our exposure to chemicals or smoke exposure, those kinds of things are in our control. The other things that we can also control are seeking out those opportunities for cancer screening, starting our mammograms when we're supposed to, doing them at the interval that is recommended, starting pap smears, starting colonoscopies, doing low dose CT scans if we did have a 30 year smoke history, there's no judgment here. We just need to get our screening done. And that could potentially prevent us from being diagnosed with a very aggressive or a very far gone cancer in most cases. Of course, there are situations where random things will happen, but just being aware of our prevention, being aware of what cancer looks like.

Those are the things that I would say can help prevent or prevent catching it, at an inopportune time.

Rania Habib, MD, DDS (Host): Thank you so much for that detailed response. You've provided us with some really thought provoking information here today, Ms. Dignan, and you've been an absolute pleasure to have on our podcast. Thank you so much for joining us, and we thank you for all that you do every day here at the Carle Cancer Institute for so many people and families.

Hannah Dignan, MSN, APRN, AGNP-BC, AOCNP, CBCN: Thank you so much for having me.

Rania Habib, MD, DDS (Host): I'm your host, Dr. Rania Habib, wishing you well. That concludes today's Hallie HealthCast. Tune in next time as we tackle yet another topic important for your health and well being. And remember, Hally Health is your partner in helping you live your healthiest life. Visit hally.com, that's H-A-L-L-Y.com, for resources, information, tips, and much more.

Let us help keep you and your family healthy and well. Thanks for listening. We hope you tune in again.